| NPI | 1164503983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 36779) |
| Additional Taxonomies | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: KY 36779) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-04-16 |