| NPI | 1356321129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD00041128) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: GA 041046) |
| 207L00000X Anesthesiology (Licence: WA MD00041128) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2013-05-13 |