| NPI | 1154883734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101290606) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 320881) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-09-01 |