| NPI | 1851355580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME54983) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA04181000) |
| 207L00000X Anesthesiology (Licence: NY 159571 1) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2015-11-20 |