| NPI | 1225071921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M4195) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX TX TEMP LICENSE) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2014-10-13 |