| NPI | 1811977994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101264181) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ME MD27085) |
| 207L00000X Anesthesiology (Licence: WY 12835C) | |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2026-01-06 |