| NPI | 1427390673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301103959) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S3505) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2019-12-05 |