| NPI | 1750777686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 53134) |
| Additional Taxonomies | 207LA0401X Anesthesiology Addiction Medicine (Licence: KY 53134) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2019-09-20 |