| NPI | 1386221729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH Pending) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000247A) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-03-26 |