| NPI | 1639131543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MA 54696) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 54696) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-08-22 |