| NPI | 1497281679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 311564) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA SP-0235) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 311564) | |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2023-07-07 |