| NPI | 1255547253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M9172) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX M9172) |
| 207L00000X Anesthesiology (Licence: MA 222347) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-09-18 |