| NPI | 1184280026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MT217617) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA11785500) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2025-07-28 |