| NPI | 1801412622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2025-03575) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2020017257) |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2026-06-02 |