| NPI | 1306053897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 8637396-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 52328) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-07-29 |