| 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 |