| NPI | 1952617110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 8865) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 67385) |
| 207L00000X Anesthesiology (Licence: NY 60246402) | |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2025-07-09 |