| NPI | 1790312254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX W0582) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 34347) |
| 208D00000X General Practice (Licence: NE 34347) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2026-06-18 |