| NPI | 1164840534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S0714) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S0714) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2022-10-24 |