| NPI | 1366557449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 37169) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: KY 37169) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-08-23 |