| NPI | 1952325698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS20105) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA 20A7333) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN 5119) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2026-02-24 |