| NPI | 1770745770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: VA 0101269525) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: LA MD.206499) |
| 207L00000X Anesthesiology (Licence: PA MD475218) | |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: IL 036152577) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2021-11-04 |