| NPI | 1184612210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C52948) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX L0669) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2016-09-20 |