| NPI | 1497982680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA R8609) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 267745) |
| 207L00000X Anesthesiology (Licence: CT 51891) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2013-06-21 |