| NPI | 1649258344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 204408-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 49224) |
| 207L00000X Anesthesiology (Licence: NY 204408) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-10-12 |