| NPI | 1720601735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA12823800) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD490765) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2025-09-25 |