| NPI | 1508012964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX p1224) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10030732) |
| Enumeration Date | 2008-08-16 |
| Last Update Date | 2020-10-07 |