| NPI | 1376508663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN MD26688) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX K3764) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TN MD26688) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX K3764) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2009-09-15 |