| NPI | 1376539957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102202159) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: KY TP015) |
| 207L00000X Anesthesiology (Licence: KY 02922) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2016-02-10 |