| NPI | 1043254147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 175517) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NY 175517) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: NY 175517) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2012-08-01 |