| NPI | 1679514905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX j6681) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: TX 6677490001) |
| 207L00000X Anesthesiology (Licence: TX J6681) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2025-03-18 |