| NPI | 1912178773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX m8869) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: TX m8869) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX m8869) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2015-10-12 |