| NPI | 1124312517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX Q2489) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 28548) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2022-07-05 |