| NPI | 1831490648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 8161839-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 8161839-8905) |
| 207R00000X Internal Medicine (Licence: AZ AT 16525452054) | |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2014-09-04 |