| NPI | 1376799056 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N9199) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 11644) | 
| Enumeration Date | 2008-08-13 | 
| Last Update Date | 2023-05-22 |