| NPI | 1538508320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR DO192395) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 04312) |
| 207L00000X Anesthesiology (Licence: IA DO-04984) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-11-01 |