| NPI | 1629452743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101239965) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ MA66203) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-18 |