| NPI | 1497758585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 195813-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA06115800) |
| 207L00000X Anesthesiology (Licence: CA C51505) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2012-01-24 |