| NPI | 1619964053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 64541688905) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 194949) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2020-11-11 |