| NPI | 1972893808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX R9145) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301111491) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2022-06-13 |