| NPI | 1215971502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB07292300) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 185194-1) |
| 207L00000X Anesthesiology (Licence: VA 0102204824) | |
| 207L00000X Anesthesiology (Licence: PA OS006492L) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2017-05-04 |