| NPI | 1760424543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 211587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 211587) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-08-18 |