| NPI | 1023047677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME116838) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA 418150) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-05-13 |