| NPI | 1013906023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 34008280) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101014507) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2025-09-16 |