| NPI | 1790746543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35065486) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD463607) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-06-06 |