| NPI | 1780940742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 282702) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.125017) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-09-19 |