| NPI | 1659455111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.084565) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 201247) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2018-03-21 |