| NPI | 1073959912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R1456) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10046712) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX R1456) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2025-10-30 |