| NPI | 1912506940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 307927) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 33325) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2025-06-30 |