| NPI | 1811304736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61473026) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2014018833) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2025-06-03 |