| NPI | 1104260025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U7840) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 64678) |
| 207L00000X Anesthesiology (Licence: AZ 53342) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2024-03-14 |