| NPI | 1518143841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P2647) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 002065) |
| 207L00000X Anesthesiology (Licence: NC 200201249) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2018-12-05 |