| NPI | 1831241983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 6058A) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WY 6058A) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2025-11-07 |