| NPI | 1194752915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR.0031561) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN MD25323) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: TN MD25323) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2018-07-23 |