| NPI | 1205464047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 333209) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101283696) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2025-11-03 |