| NPI | 1568467694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 148373) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 148731) |
| 207L00000X Anesthesiology (Licence: PA 029912E) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2011-05-25 |