| NPI | 1073565321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101252514) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35077560) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2024-04-23 |