| NPI | 1164879342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T0246) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC MMD.39438.LL) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2021-08-06 |