| NPI | 1629081013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: NJ 25ma08092000) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA08092000) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2017-04-11 |