| NPI | 1558326827 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA MD.202840) | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35057477) | 
| Enumeration Date | 2006-04-19 | 
| Last Update Date | 2010-03-03 |