| NPI | 1922487172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD227663) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 27366) |
| 207L00000X Anesthesiology (Licence: MN 60958) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2025-12-16 |