| NPI | 1366192874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD.MD.70087445) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.153644) |
| Enumeration Date | 2022-03-27 |
| Last Update Date | 2026-09-21 |