| NPI | 1598057416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 311541) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032827-1) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 311541) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2022-12-29 |