| NPI | 1427436013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NY 31623501) |
| Additional Taxonomies | 208600000X Surgery (Licence: RI LP03339) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2022-08-12 |