| NPI | 1861719924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.127598) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 47296) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2021-07-01 |