| NPI | 1063492205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 78202) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME73002) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2021-07-08 |