| NPI | 1063861854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IN 75000151A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000276) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-11-06 |