| NPI | 1114958717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 234524) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: NY 234524) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2015-12-09 |