| NPI | 1063415982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 202028) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101268941) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2026-03-18 |