| NPI | 1356537062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: UT 7625390-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.012945) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2011-10-06 |