| NPI | 1215344494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.133517) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R3484) |
| Enumeration Date | 2014-07-19 |
| Last Update Date | 2026-08-05 |