| NPI | 1790244804 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V1567) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 13249347-1204) | 
| 207L00000X Anesthesiology (Licence: IA DO-07073) | |
| Enumeration Date | 2019-03-18 | 
| Last Update Date | 2025-07-24 |