| NPI | 1538149810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS012221) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102050203) |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: PA OS012221) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-06-03 |