| NPI | 1023112455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: FL ME159319) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 10971) |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: MA 71089) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2024-04-10 |