| NPI | 1215195763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T4522) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35-124320) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2022-10-10 |