| NPI | 1811262025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 8831896-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD222909) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2025-03-05 |