| NPI | 1558317891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 33513) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.069868) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-02-02 |