| NPI | 1881670552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 33096) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME99404) |
| 207P00000X Emergency Medicine (Licence: AL MD.30804) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2025-03-25 |