| NPI | 1720528771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 34.015257) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 34.015257) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 34.015257) | |
| Enumeration Date | 2017-02-24 |
| Last Update Date | 2025-04-23 |