| NPI | 1962525865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 207L00000X) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2025011933) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2025-04-23 |