| NPI | 1932513728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 33956) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10054573) |
| 207R00000X Internal Medicine (Licence: NE 7219) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-12-16 |