| NPI | 1093199077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: KY 54165) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 54165) |
| Enumeration Date | 2015-07-19 |
| Last Update Date | 2021-07-29 |