| NPI | 1174918395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME107270) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA10933900) |
| 207L00000X Anesthesiology (Licence: PA MD471305) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: PA MD471305) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NJ 25MA10933900) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2022-02-03 |