| NPI | 1740785088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 291045) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.027475) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 291045) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-05-02 |