| NPI | 1093010738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS11736) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S5504) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX S5504) | |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2025-03-05 |