| NPI | 1740278019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX L9003) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX L9003) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2023-11-02 |