| NPI | 1770781940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101259619) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 28740) |
| 282NC2000X General Acute Care Hospital Children | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-03-24 |