| NPI | 1003172495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 5068619-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD222759) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2025-01-15 |