| NPI | 1639583255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.132890) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 30698) |
| Enumeration Date | 2014-06-12 |
| Last Update Date | 2018-07-05 |