| NPI | 1609858612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 38010) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35060078D) |
| 174400000X Specialist (Licence: KY 38010) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2010-05-12 |