| NPI | 1306028063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 051248) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 265515) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2019-10-26 |