| NPI | 1902882228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 9400103) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2011007121) |
| 207L00000X Anesthesiology (Licence: NM MD2005-0464) | |
| 208000000X Pediatrics (Licence: NM MD2005-0464) | |
| 208000000X Pediatrics (Licence: NC 9400103) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-04-07 |