| NPI | 1356683643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.133626) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.133626) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.133636) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2022-02-04 |