| NPI | 1649218611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NV 10083) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX K9827) |
| 207L00000X Anesthesiology (Licence: CA C134131) | |
| 207L00000X Anesthesiology (Licence: OR MD207244) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-02-05 |