| NPI | 1164717633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 75055) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10039725) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-11-19 |