| NPI | 1205289741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D0101868) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME158285) |
| 207L00000X Anesthesiology (Licence: NY 305514) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2024-11-20 |