| NPI | 1245658533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.137187) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| 207L00000X Anesthesiology (Licence: IN 01088956A) | |
| 207L00000X Anesthesiology (Licence: KY 52648) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2023-04-11 |