| NPI | 1891857785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2004001428) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 04-17542) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KS 04-17542) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2025-09-11 |