| NPI | 1124264148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 250497) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 250497) |
| Enumeration Date | 2008-12-22 |
| Last Update Date | 2019-03-26 |