| NPI | 1003279811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 300270) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 1021784) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2025-10-30 |