| NPI | 1508946443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 203824) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD058580L) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-09-20 |