| NPI | 1619402153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.146303) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57030450) |
| 207L00000X Anesthesiology (Licence: OH 35.146303) | |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2022-09-16 |