| NPI | 1912902503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M0202) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35082251O) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2022-09-16 |