| NPI | 1164607321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S4975) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301083985) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2020-05-13 |