| NPI | 1104244631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 57811) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 57.245211) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2022-06-03 |