| NPI | 1225599087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 79149) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA11898300) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-09-05 |