| NPI | 1043576051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NC 2018-02992) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 201802992) |
| 207L00000X Anesthesiology (Licence: OH 35.128567) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 85079) | |
| 208VP0000X (Licence: SC 85079) | |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2026-02-06 |