| NPI | 1518925882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MN 52894) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 45049) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: OH 35.089468) | |
| 207L00000X Anesthesiology (Licence: OH 35.089468) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OH 35.089468) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-02-01 |