| NPI | 1629497433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT MED-PHYS-LIC-81144) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA ML60756168) |
| 208000000X Pediatrics (Licence: WI 65209-20) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2020-07-09 |