| NPI | 1104489236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 327588) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 327588) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-06-11 |