| NPI | 1811379696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 300136) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263318) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2019-07-17 |