| NPI | 1366754251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA 144568) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA 195115) |
| 207L00000X Anesthesiology (Licence: PA MD447752) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NV 15209) | |
| 207L00000X Anesthesiology (Licence: NV 15209) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: PA MD447752) | |
| 207L00000X Anesthesiology (Licence: MA 254943) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 254943) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2022-02-11 |