| NPI | 1972591543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25MA06176900) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD053908L) |
| 207L00000X Anesthesiology (Licence: DE C1-0004879) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2015-03-19 |