| NPI | 1760863625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA 20A16509) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S0124) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2022-03-24 |