| NPI | 1508868019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 222248) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA07449600) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2008-08-05 |