| NPI | 1104823921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA03175300) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA31753) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2013-07-22 |