| NPI | 1407146913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.126149) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0116023243) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2022-02-25 |