| NPI | 1811101751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 28877) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M9355) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX M9355) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2013-03-07 |