| NPI | 1952695264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35131346) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME128189) |
| 208600000X Surgery (Licence: PA MT199893) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2022-07-21 |