| NPI | 1700839800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: CT 30775) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 30775) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2016-12-27 |