| NPI | 1508483959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB12089300) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 284858) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2025-07-14 |