| NPI | 1568585081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA MD42437) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: OH 57.023992) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2017-04-26 |