| NPI | 1679730204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60125703) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P1378) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX P1378) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD60125703) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX P1378) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2020-02-14 |