| NPI | 1306121736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.057820) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.057820) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |