| NPI | 1073514162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 29378) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 31566) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2026-03-09 |