| NPI | 1285610501 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 75207) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J4835) |
| 208D00000X General Practice (Licence: CA g72968) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2025-01-08 |