| NPI | 1164512059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD00021726) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00021726) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2009-02-05 |