| NPI | 1073909313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA11491000) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 296538) |
| 207L00000X Anesthesiology (Licence: IA DO-05777) | |
| 207L00000X Anesthesiology (Licence: OR DO206782) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2022-10-12 |