| NPI | 1730151861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 185861-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 6689) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2013-01-10 |