| NPI | 1609927763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 29954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD 426865) |
| 207L00000X Anesthesiology (Licence: PA MD 426865) | |
| 207L00000X Anesthesiology (Licence: MD D82395) | |
| 207L00000X Anesthesiology (Licence: OH 35.086797) | |
| 207L00000X Anesthesiology (Licence: VA 0101261414) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-07-03 |