| NPI | 1760758478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 51895) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 127442) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2022-08-23 |