| NPI | 1003561929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 11047804) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 0020482) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2026-08-28 |