| NPI | 1548606635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 82797) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 50526) |
| 207L00000X Anesthesiology (Licence: PA MT203567) | |
| 207L00000X Anesthesiology (Licence: KY TP767) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2019-04-22 |