| NPI | 1164407904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P5574) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME85638) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-07-19 |