| NPI | 1639339096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 57886) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD28282) |
| 207L00000X Anesthesiology (Licence: NY 258492) | |
| 207L00000X Anesthesiology (Licence: KY TP347) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-04-11 |