| NPI | 1558568048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N9234) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301090251) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2020-07-01 |