| NPI | 1780244731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 58082) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2019021882) |
| 207L00000X Anesthesiology (Licence: KY TP594) | |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2023-10-25 |