| NPI | 1659710770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 096931) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 096931) |
| 207Q00000X Family Medicine (Licence: OH 35.134298) | |
| 208D00000X General Practice (Licence: OH 35.134298) | |
| 208D00000X General Practice (Licence: CT 56149) | |
| 208D00000X General Practice (Licence: KY 55174) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-07-21 |