| NPI | 1043607518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 144891) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 303753) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: FL 144891) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NY 303753) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2021-12-17 |