| NPI | 1790909430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: OK 47769) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-05929 temporary) |
| 207L00000X Anesthesiology (Licence: FL ME107931) | |
| 207L00000X Anesthesiology (Licence: ME MD29968) | |
| 207L00000X Anesthesiology (Licence: NH 34112) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2026-08-11 |