| NPI | 1780115253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 55520) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R4330) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2021-06-29 |