| NPI | 1578622890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX U4942) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL UO1280) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2025-07-31 |