| NPI | 1972123313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY R78017) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R78017) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2021-07-19 |