| NPI | 1871177337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101286786) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2026-04461) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2026-08-03 |