| NPI | 1245112242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 337152) |
| Additional Taxonomies | 208D00000X General Practice (Licence: 1125951) |
| 207L00000X Anesthesiology (Licence: 141859) | |
| Enumeration Date | 2025-07-22 |
| Last Update Date | 2026-03-09 |