| NPI | 1184828774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: TX N5439) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP1-0022241) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2019-12-05 |