| NPI | 1639515596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB10373800) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 329064) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2024-05-22 |