| NPI | 1194925644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA08741600) |
| Additional Taxonomies | 275N00000X Medicare Defined Swing Bed Unit (Licence: NY 240836) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2011-09-21 |