| NPI | 1487657656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD450154) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA07779700) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2015-03-20 |