| NPI | 1083906952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 9395169-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301096041) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2018-02-27 |