| NPI | 1417011875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA 40072) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: IA MD-40072) |
| 208D00000X General Practice (Licence: VA 0101246556) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-11-16 |