| NPI | 1376920546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 299725) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A183520) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 299725) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2025-04-23 |