| NPI | 1134758790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U9350) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS NA) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX U9350) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-05-13 |