NPI | 1770770190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: WA MD60152821) |
Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A103141) |
Enumeration Date | 2007-09-30 |
Last Update Date | 2012-03-06 |