| NPI | 1598756637 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M3699) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 00015132) | 
| Enumeration Date | 2005-10-28 | 
| Last Update Date | 2014-10-13 |