| NPI | 1417912148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD057248L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35072180p) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-10-08 |