| NPI | 1346390887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME128156) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA md00040825) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD00040825) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2022-05-17 |