| NPI | 1740221605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: OH 35-076522) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35076522) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2026-07-06 |