| NPI | 1285631671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 162810) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ MA 51764) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2025-08-19 |