| NPI | 1205193059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 287250-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD457282) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63193) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2018-03-17 |