| NPI | 1114912375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD488323) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 208415) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NY 208415) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: PA MD488323) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2025-03-06 |