| 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 |