| NPI | 1366679847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N4541) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS014784) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2020-10-01 |