| NPI | 1659710986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 11337788-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 256054) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-11-11 |