| NPI | 1447455803 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.097119)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 49718)  | 
| Enumeration Date | 2007-06-18 | 
| Last Update Date | 2012-09-17 |