| NPI | 1770533689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 52853) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: TX E3620) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-08-12 |