| NPI | 1407000763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N6500) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 246109-1) |
| 207L00000X Anesthesiology (Licence: CA C55962) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2025-09-22 |