| NPI | 1720373400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: UT 11234377-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R-9232) |
| 207L00000X Anesthesiology (Licence: WI 64180) | |
| 207L00000X Anesthesiology (Licence: OR DO176139) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WI 64180) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2023-03-22 |