| NPI | 1497148092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA 61411195) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 29500) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2023-08-11 |