| NPI | 1619953445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD055398L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX K0955) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-01-17 |