| NPI | 1275832529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME147571) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 257217) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MI 4301110378) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2022-03-18 |