| NPI | 1922366350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-01259) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R1429) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2023-05-19 |