| NPI | 1871768887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 41898) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57-010852) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2022-12-02 |