| NPI | 1790965507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P1525) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OS014782) |
| Enumeration Date | 2007-11-08 |
| Last Update Date | 2022-02-01 |