| NPI | 1619945250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 112407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 112407) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NY 112407) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2008-04-10 |