| NPI | 1265794861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 51808) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2017-01339) |
| 207L00000X Anesthesiology (Licence: FL ME127465) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2019-05-19 |