| NPI | 1003443433 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MD D0103248)  | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD 5331)  | 
| Enumeration Date | 2020-03-25 | 
| Last Update Date | 2025-06-06 |