| NPI | 1891809323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101222394) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO MD108859) |
| 207L00000X Anesthesiology (Licence: PA MD070813L) | |
| 207L00000X Anesthesiology (Licence: MD D0056172) | |
| 207L00000X Anesthesiology (Licence: OH 35078128H) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2020-03-11 |