| NPI | 1821417403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY TP565) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0116027271) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2017-02-09 |