| NPI | 1770586893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60313188) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX L8261) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-10-22 |