| NPI | 1619951282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 180354) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 50905) |
| 207L00000X Anesthesiology (Licence: NJ 25MA09149000) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2012-09-07 |