| NPI | 1578664892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 5685713-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00044212) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-11-04 |