| NPI | 1265644629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A112605) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT188671) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA A112605) | |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2016-06-01 |