| 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 |