| NPI | 1942888128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61674210) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 79771) |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-08-13 |