| NPI | 1104454255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA A196169) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A196169) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-08-01 |