| NPI | 1538124524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MN 60119) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 48397) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2023-01-04 |