| NPI | 1306154315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.123978) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT197987) |
| 208D00000X General Practice (Licence: VA 0101251168) | |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2024-04-05 |