| NPI | 1710072574 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 249628-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD422956) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-03-10 |