| NPI | 1851590863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD459660) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA09511300) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2023-01-04 |