| NPI | 1851659205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.131997) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA T60325721) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2019-03-12 |