| NPI | 1366891889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12147502-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R-10565) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-07-01 |