| NPI | 1760829709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 88518) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 52311) |
| 207L00000X Anesthesiology (Licence: TX R2068) | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2024-12-18 |