| NPI | 1053718189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 1020793) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Pending) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX Pending) | |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2024-09-10 |