| NPI | 1649625419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 11216087-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD222776) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2025-01-27 |