| NPI | 1194259481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T8233) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1925) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-04-19 |