| NPI | 1730570516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD61069714) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2016019262) |
| 208000000X Pediatrics (Licence: WA MD61069714) | |
| Enumeration Date | 2015-02-14 |
| Last Update Date | 2023-02-24 |