| NPI | 1003201971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301502502) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 278685) |
| 208D00000X General Practice (Licence: OH 130635) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2020-06-22 |