| NPI | 1396040481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 262199) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 277608) |
| 207L00000X Anesthesiology (Licence: PA MD453236) | |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2015-08-07 |