| NPI | 1659393387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25IA12554800) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 84585) |
| 207L00000X Anesthesiology (Licence: MD DO064277) | |
| 207L00000X Anesthesiology (Licence: SC 94330) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-11-03 |