| NPI | 1457616518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IN 75000149A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000196) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2023-10-30 |