| NPI | 1346603628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12213149-1205) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TN 61379) |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2021-10-16 |