| NPI | 1811984354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35074277) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 19249) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2023-05-01 |