| NPI | 1861791329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX Q3040) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDR.0002531) |
| 207L00000X Anesthesiology (Licence: GU MC-138) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX Q3040) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2023-09-28 |