| NPI | 1639173347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 170125) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NY 170125) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2007-07-08 |