| NPI | 1861871337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: TX U1683) |
| Additional Taxonomies | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: CA 169625) |
| 207R00000X Internal Medicine (Licence: PA MT209348) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2023-02-10 |