| NPI | 1710101605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 246982) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101249255) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2026-01-20 |