| NPI | 1619907367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 137167-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 137167) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2023-07-22 |