| NPI | 1003049842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 280886) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101257415) |
| 207L00000X Anesthesiology (Licence: NY 275400) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2019-06-17 |