| NPI | 1205217759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 85618) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC MMD.38359 LL) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: GA 85618) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2023-04-28 |