| NPI | 1962698746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 6358989-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WY 8046A) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2016-09-01 |