| NPI | 1710088539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 159785) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 159785-1) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-01-14 |