| NPI | 1679815740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R9484) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2021019890) |
| 207L00000X Anesthesiology (Licence: CA 15455) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-09-20 |