| NPI | 1629430624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.138846) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.027812) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2026-01-16 |