| NPI | 1639437296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101260119) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX U1153) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101260119) | |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2025-05-22 |