| NPI | 1790206415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A204747) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 310826) |
| 208VP0000X (Licence: NY 310826) | |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2026-08-04 |