| NPI | 1639187115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: SC 24474) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC TL24474) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC TL24474) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2021-05-06 |