| NPI | 1376953539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: UT 11019100-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 5101023699) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2019-09-03 |