| NPI | 1629196167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB08537400) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT011693) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-09-15 |