| NPI | 1821676693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61546577) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD61546577) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-06-30 |