| NPI | 1194348573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61677657) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10070754) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2025-07-24 |