| NPI | 1942463401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 67040) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35-132821) |
| 207L00000X Anesthesiology (Licence: MO 2013009611) | |
| 207L00000X Anesthesiology (Licence: OK 37638) | |
| Enumeration Date | 2008-07-05 |
| Last Update Date | 2023-02-01 |