| NPI | 1063472553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 79447) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 13262) |
| 207L00000X Anesthesiology (Licence: RI MD15335) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2016-09-15 |