| NPI | 1124466123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R8303) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT205030) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-11-18 |