| NPI | 1053336925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME116944) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 239864-1) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-12-18 |