| NPI | 1487643581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 200700171) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD425214) |
| 207L00000X Anesthesiology (Licence: NJ 25MA08508000) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2018-01-24 |