| NPI | 1497140560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12208311-1205) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 12208311-1205) |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2021-10-13 |