| NPI | 1881339539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301513825) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351050142APP22) |
| Enumeration Date | 2022-04-27 |
| Last Update Date | 2025-03-17 |