| NPI | 1639171531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 38048) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 31371) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2026-04-06 |