| NPI | 1568697936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 46224) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT195452) |
| 207L00000X Anesthesiology (Licence: OH 35.121802) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2014-03-06 |