| NPI | 1679547814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME131876) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35069711) |
| 207L00000X Anesthesiology (Licence: GU M001356) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-03-17 |