| NPI | 1568464121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0024168214) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD423207) |
| 207L00000X Anesthesiology (Licence: NJ 25MA07784900) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2019-10-10 |