| NPI | 1487882395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ND 14122) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 60712) |
| 207L00000X Anesthesiology (Licence: MA 254658) | |
| 207L00000X Anesthesiology (Licence: OH 35.125684) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2025-07-25 |