| NPI | 1982699922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2026039196) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 153106) |
| 207L00000X Anesthesiology (Licence: MD D50153) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2026-09-24 |