| NPI | 1629334321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R3764) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 75929) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-11-24 |