| NPI | 1174590210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX 46220) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 32827) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-02-08 |