| NPI | 1124361720 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 34-006651)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102050017)  | 
| 207L00000X Anesthesiology (Licence: DC DO034371)  | |
| Enumeration Date | 2013-04-02 | 
| Last Update Date | 2013-04-02 |