| NPI | 1376939306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CT 65881) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 65881) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 278127) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2021-10-11 |