| NPI | 1912394859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S5693) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA MD16602) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2024-10-31 |