| NPI | 1003804535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 52289) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 52031) |
| 207L00000X Anesthesiology (Licence: NC 200000650) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NC 200000650) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2019-05-01 |