| NPI | 1366403024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M6573) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301080295) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-11-21 |