| NPI | 1386081206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.133588) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R73975) |
| Enumeration Date | 2013-06-01 |
| Last Update Date | 2018-09-18 |