| NPI | 1356353411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101238028) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 232152-1) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-02-19 |