| NPI | 1942704721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 71562) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME154210) |
| 207L00000X Anesthesiology (Licence: WI 84237-20) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-10-15 |