| NPI | 1720063563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 214576-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA07112100) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2014-10-01 |