| NPI | 1154783637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NY 308564) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2021-05-20 |