| NPI | 1730614470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB12661400) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 02006430A) |
| 171000000X Military Health Care Provider (Licence: IN 02006430A) | |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2025-09-30 |