| NPI | 1033643507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.152675) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2021-02256) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-07-13 |