| NPI | 1063647477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY TP659) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.015011) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2022-10-05 |