| NPI | 1144664798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61043322) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10046234) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2021-04-26 |