| NPI | 1588907240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 288525) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25ma10388000) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2025-06-12 |