| NPI | 1972985323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 73159) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 304714) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2024-04-01 |