| NPI | 1710959978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 250399) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 224224) |
| 207R00000X Internal Medicine (Licence: CA AFE82649) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: NY 250399) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2012-02-08 |