| NPI | 1801874391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 42007) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 1785) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2018-10-02 |