| NPI | 1962449017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35087466) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 21517) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-04-09 |