| NPI | 1053949909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 76488-20) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WI 76488-20) |
| 208000000X Pediatrics (Licence: WI 76488-20) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-07-30 |