| NPI | 1962062091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301509519) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX V0362) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2024-06-07 |