| NPI | 1891021176 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX N9315) | 
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX N9315) | 
| Enumeration Date | 2009-10-21 | 
| Last Update Date | 2024-01-25 |