| NPI | 1760616817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 47076) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 47076) |
| 207L00000X Anesthesiology (Licence: NC 2013-01259) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2021-01-15 |