| NPI | 1003081191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 113050) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 264172-1) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2013-08-13 |