| NPI | 1619364726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 315109) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD194535) |
| 207L00000X Anesthesiology (Licence: CT 71748) | |
| 207L00000X Anesthesiology (Licence: ME MD29090) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CT 71748) | |
| 363AM0700X Physician Assistant, Medical (Licence: NY 315109) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2025-02-07 |