| NPI | 1043521628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME154360) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL TRN14924) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2022-02-08 |