| NPI | 1184075830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S6430) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2016020260) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2020-07-02 |