| NPI | 1982281259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MN 78994) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 24987) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-08-21 |