| NPI | 1639389083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60131006) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 99080) |
| 207L00000X Anesthesiology (Licence: MA 236123) | |
| 207L00000X Anesthesiology (Licence: TX N3208) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2019-10-22 |