| NPI | 1457343816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35082201) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301082970) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2021-03-27 |