| NPI | 1659566552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P1891) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 017596) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2012-07-19 |