| NPI | 1285602979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 150506-1) |
| Additional Taxonomies | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: NY 150506-1) |
| 207L00000X Anesthesiology (Licence: NY 150506) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-01-18 |