| NPI | 1134110265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MA 36547) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 36547) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-07-08 |