| NPI | 1770903387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S1599) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10049542) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-02-12 |