| NPI | 1790878460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 5537276-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 333124-01) |
| 207L00000X Anesthesiology (Licence: ND 21274) | |
| 207L00000X Anesthesiology (Licence: OR DO222743) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-03-11 |