| NPI | 1811200249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60600145) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA mt192368) |
| Enumeration Date | 2010-07-14 |
| Last Update Date | 2025-08-27 |