| NPI | 1588664544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 42498) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35085861) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2018-01-24 |