| NPI | 1306872437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 8813619-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM MD2006-0121) |
| 207L00000X Anesthesiology (Licence: WI 102231-875) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-11-07 |