| NPI | 1053586792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 257076) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA08796000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2021-06-03 |