| NPI | 1245434679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PR 16273) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 237441) |
| 208D00000X General Practice (Licence: NY 237441) | |
| 208D00000X General Practice (Licence: PR 16273) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2021-03-24 |