| NPI | 1710391065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D91616) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC LL37110) |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2021-07-07 |