| NPI | 1104888684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OK 47671) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 77576) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KY C5580) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2026-05-20 |