| NPI | 1629061064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 232673 - 1) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 232673) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2015-08-14 |