| NPI | 1841280575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: KY 24377) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 24377) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2020-10-29 |