| NPI | 1104884204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA 039393E) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA05123600) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-05-07 |