| NPI | 1720215965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 053870) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35.121420) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 053870) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CT 053870) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2023-08-23 |