| NPI | 1639608359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S9619) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10061459) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2025-08-29 |