| NPI | 1407011604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 237402) |
| Additional Taxonomies | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: AR E-12050) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2019-03-19 |