| NPI | 1699180505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NM DO2023-0178) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH AP2282058A31) |
| 207L00000X Anesthesiology (Licence: MI 5101022104) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2024-06-05 |