| NPI | 1619106978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ R71631) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KS 04-38950) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MO 2016012562) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2025-12-18 |