| NPI | 1639154107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX J5687) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 55789) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2025-02-04 |