| NPI | 1285079293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 289258-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 289258) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2020-02-24 |