| NPI | 1548255193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 43068) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35084151) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2017-04-20 |