| NPI | 1104015213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.092655) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.092655) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 32734) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2023-02-08 |