| NPI | 1790986214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 58243) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 253940) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2021-06-07 |