| NPI | 1104203959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 5827853-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 9408556) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2019-08-29 |