| NPI | 1407847858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 261164) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 25922) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 261164-1) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN MD51947) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 261164) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2023-07-22 |