| NPI | 1104884063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD H0082720) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 34-003628) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MI 5101008315) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: SD 9292) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2026-03-05 |