| NPI | 1043690712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: WV 29723) |
| Additional Taxonomies | 208VP0000X (Licence: OH 35.139422) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 29723) | |
| 208600000X Surgery (Licence: WV 29723) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2026-01-08 |