| NPI | 1558434548 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ MB06999700) | 
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NJ MB06999700) | 
| Enumeration Date | 2006-11-16 | 
| Last Update Date | 2008-01-17 |