| NPI | 1619230117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 268744) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 268744) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2020-11-19 |