| NPI | 1053739409 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 007828)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME135058)  | 
| Enumeration Date | 2014-04-02 | 
| Last Update Date | 2023-12-04 |