| NPI | 1730455908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 61630) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 61584) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WI 61584) | |
| Enumeration Date | 2012-03-31 |
| Last Update Date | 2018-03-17 |