| NPI | 1225356355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042.0012930) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 272912) |
| 207L00000X Anesthesiology (Licence: NJ 25MA09563000) | |
| 207L00000X Anesthesiology (Licence: NH 17811) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2017-01-30 |