| NPI | 1538152772 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35-065743) | 
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 35-065743) | 
| Enumeration Date | 2005-08-23 | 
| Last Update Date | 2008-05-29 |