| NPI | 1740594886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: PA os017014) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL os17199) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: VA 0102204876) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT013530) | |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2020-10-12 |