| NPI | 1538167309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35043389) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: OH 35.043389) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2025-07-30 |