| NPI | 1932553658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61344889) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 34.016000) |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2022-10-05 |