| NPI | 1104034438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: ID O-0626) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 936767) |
| 207L00000X Anesthesiology (Licence: ID O-0626) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2011-07-26 |