| NPI | 1619219193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MO 2022015524) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34012359) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: KS 94-10101) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2025-12-18 |