| NPI | 1164718623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA 60901530) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ME D03236) |
| 208D00000X General Practice (Licence: NE 1012) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-06-17 |