| NPI | 1457318586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 30014176) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.014176) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2009-12-11 |