| NPI | 1477818250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: MA 267497) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA FS2328169-469) |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2018-03-17 |