| NPI | 1982841680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 62421) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD452187) |
| 207L00000X Anesthesiology (Licence: NJ 25MA08529100) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: CT 62421) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: PA MD452187) | |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2020-04-03 |