| NPI | 1932580578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX 594130) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX 594130) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2022-03-02 |