| NPI | 1972514404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME35415) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: FL ME35415) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME35415) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2017-06-20 |