| NPI | 1205221751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 290535) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 62370) |
| 207L00000X Anesthesiology (Licence: NJ 25MA10986400) | |
| 207L00000X Anesthesiology (Licence: NY 304103) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 290535) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2023-05-01 |