| NPI | 1164954566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A172134) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NJ 390200000) |
| 207L00000X Anesthesiology (Licence: NJ 390200000) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2022-09-29 |