| NPI | 1891967675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 245778) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 57.013921) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 245778) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2023-03-22 |