| NPI | 1235528530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T3425) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 008105) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: AZ 008105) | |
| Enumeration Date | 2015-01-10 |
| Last Update Date | 2024-12-30 |