| NPI | 1053359794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 152000) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME157867) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2025-12-12 |