| NPI | 1871780841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 242125) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 242125) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2023-05-31 |