| NPI | 1184251902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA12193700) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 2086S0129X Surgery Vascular Surgery (Licence: NJ 25MA12193700) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2025-07-28 |