| NPI | 1053718189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX PENDING) |
| Additional Taxonomies | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: TX PENDING) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2021-02-18 |