| NPI | 1871889626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: TX S3989) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2015-00069) |
| 207L00000X Anesthesiology (Licence: PA MT198984) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2021-12-07 |