| NPI | 1881603199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 84-171901-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 34100) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2026-06-12 |