| NPI | 1215986773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 156424 1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA05061300) |
| 207L00000X Anesthesiology (Licence: LA MD 014741) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-04-30 |