| NPI | 1639279136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P5524) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102201923) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2020-04-28 |