| NPI | 1104934058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 17144) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 264677) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-05-22 |