| NPI | 1174901888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD60869140) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60869140) |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2020-09-03 |