NPI | 1518212919 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: DC MD500002936) |
Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 89915) |
207L00000X Anesthesiology (Licence: VA 0101254962) | |
Enumeration Date | 2012-07-21 |
Last Update Date | 2025-08-14 |