| NPI | 1811099773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M5804) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: DC MD32615) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: TX M5804) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2014-02-27 |