| NPI | 1760502991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 6919190-1240) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-06211 temporary) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2015-06-19 |