| NPI | 1295129369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: OH 35.132189) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.132189) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 0002216264) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-08-12 |