| NPI | 1700847530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD039311E) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J1792) |
| 207L00000X Anesthesiology (Licence: NC 19828) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2018-03-28 |