| NPI | 1962898825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2021044086) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 84627) |
| 207L00000X Anesthesiology (Licence: ME DO3213) | |
| 207L00000X Anesthesiology (Licence: IA DO-05137) | |
| 207L00000X Anesthesiology (Licence: ND 19119) | |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: IA DO-05137) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2024-08-01 |