| NPI | 1568646818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101253918) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30.016732) |
| 207L00000X Anesthesiology (Licence: OH 35091962) | |
| Enumeration Date | 2007-12-21 |
| Last Update Date | 2015-03-27 |