| NPI | 1972800308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.139588) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101252379) |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2021-06-21 |