| NPI | 1124080262 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.066655) | 
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: OH 35.066655) | 
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 35.066655) | |
| 207LH0002X Anesthesiology, Hospice and Palliative Medicine (Licence: OH 35.066655) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.066655) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.066655) | |
| Enumeration Date | 2006-04-04 | 
| Last Update Date | 2010-08-18 |