| NPI | 1003347790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 10957030-1205) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: UT 10957030-1205) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2023-08-23 |