| NPI | 1629250162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67000129) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 75000135A) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2023-07-27 |