| NPI | 1063415925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N4715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101045309) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2022-08-11 |