| NPI | 1790515195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA Mt233174) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 57.255867) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2025-08-05 |