| NPI | 1568496008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042-0006834) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 144954) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-07-08 |