| NPI | 1811129711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MB05679600) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MB05679600) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2009-08-11 |