| NPI | 1245112242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 337152) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ZZ 141859) |
| 208D00000X General Practice (Licence: ZZ 1125951) | |
| Enumeration Date | 2025-07-22 |
| Last Update Date | 2025-07-22 |