| NPI | 1104881424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101245046) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35087110) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-02-16 |