| NPI | 1306232251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: FL ME162410) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2020-00373) |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: TX U5226) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2024-05-09 |