| NPI | 1700884426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N1352) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 026179) |
| 207L00000X Anesthesiology (Licence: LA MD026179) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-11-29 |