| NPI | 1114042579 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R3176) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 24229s) | 
| Enumeration Date | 2007-03-21 | 
| Last Update Date | 2025-08-20 |