| NPI | 1356753370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S3310) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 79483) |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2019-11-25 |