| NPI | 1609943141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 220087-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 216121) |
| 207L00000X Anesthesiology (Licence: FL ME83842) | |
| 207L00000X Anesthesiology (Licence: WV 20558) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-08 |