| NPI | 1912102195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-00437) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 45824) |
| 207L00000X Anesthesiology (Licence: KY TP094) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2024-09-17 |