| NPI | 1164670030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35-093811) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH APPROVAL LETTER PEND) |
| 207L00000X Anesthesiology (Licence: FL ME 116008) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2014-08-11 |