| NPI | 1508031931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 258519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: NJ 25MA09088000) | |
| Enumeration Date | 2008-04-27 |
| Last Update Date | 2019-11-13 |