| NPI | 1679725105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2017017632) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 34.010937) |
| 207L00000X Anesthesiology (Licence: OH 58.002740) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 34.010937) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2021-04-01 |