| NPI | 1104896349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA07835600) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME 90934) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-08 |