| NPI | 1104402817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 93931) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 58.031926) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-07-31 |