| NPI | 1164646535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 48207) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.007361) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TN 48207) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2016-11-15 |