| NPI | 1760610521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R4416) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301095073) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2020-08-25 |