| NPI | 1154522308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V6509) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57012275) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2025-08-14 |