| NPI | 1154374023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: KY 44280) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD25940) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 35.142062) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-07-09 |