| NPI | 1255525390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX P5268) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P5268) |
| 207L00000X Anesthesiology (Licence: MA 233307) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2019-05-17 |