| NPI | 1154814556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-02965) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S3012) |
| 207L00000X Anesthesiology (Licence: NC 202302965) | |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2025-05-07 |