| NPI | 1508807868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD436554) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: LA 51022) |
| 372500000X Chore Provider (Licence: VA 00001123258) | |
| 207L00000X Anesthesiology (Licence: TN MD0000041348) | |
| 207L00000X Anesthesiology (Licence: KY 43891) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2014-07-15 |