| NPI | 1710389507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A156412) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2024041564) |
| 207L00000X Anesthesiology (Licence: IA MD-55417) | |
| 207L00000X Anesthesiology (Licence: TX S1295) | |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: MO 2024041564) | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2025-08-15 |