| NPI | 1295962173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX BP10045674) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL3375) |
| 207L00000X Anesthesiology (Licence: CA 114782) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2014-04-11 |