| NPI | 1720513112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25mb10660700) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 307352-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2024-08-10 |