| NPI | 1205824745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 9701366) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 52094) |
| 207L00000X Anesthesiology (Licence: KY TP044) | |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2019-02-26 |