| NPI | 1609294180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD466302) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA10496300) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2020-05-07 |