| NPI | 1639193667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101241745) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35-063426) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2026-04-13 |