| NPI | 1811967177 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.083722) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.083722) | 
| 207L00000X Anesthesiology (Licence: OH 35.083722) | |
| Enumeration Date | 2006-01-26 | 
| Last Update Date | 2025-08-12 |