| NPI | 1184942054 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N5671)  | 
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX N5671)  | 
| Enumeration Date | 2010-05-17 | 
| Last Update Date | 2022-02-14 |