| NPI | 1578026548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 3013528) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 3013528) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-08-21 |