| 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 |