| NPI | 1093958993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD451195) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.099114) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2014-07-14 |