| NPI | 1790952117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX p0101) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2022-04-06 |