| NPI | 1700015161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C181302) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 304426) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NE 27843) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CA C181302) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MI 4301504213) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2023-09-21 |