| NPI | 1720475833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TN 55525) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 55525) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2022-03-31 |