| NPI | 1205034196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 232274) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME75926) |
| 208000000X Pediatrics (Licence: FL ME75926) | |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2011-11-28 |