| NPI | 1528460094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 296166) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 296166) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2023-07-17 |