| NPI | 1982999512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 75102) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 261750) |
| 207L00000X Anesthesiology (Licence: TX BP10039716) | |
| 207L00000X Anesthesiology (Licence: NC 2018-02735) | |
| Enumeration Date | 2011-06-11 |
| Last Update Date | 2025-02-21 |