| NPI | 1578142428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA 1578142428) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA12894100) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-10-14 |