| NPI | 1134115413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 39610) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY TP965) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY TP965) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2022-08-29 |