| NPI | 1770711988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY TP222) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 36662) |
| 207L00000X Anesthesiology (Licence: GA 65249) | |
| 207L00000X Anesthesiology (Licence: NC 2016-01275) | |
| 207Q00000X Family Medicine (Licence: GA 003636) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2017-11-16 |