| NPI | 1790199776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 13362826-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA OP61540620) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2024-06-12 |