| NPI | 1619231677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R3980) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10042975) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2020-09-23 |