| NPI | 1760844294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY TP200) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R4159) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2020-06-10 |