| NPI | 1962556860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 201675) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO 0040809) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 201675) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-07-22 |