| NPI | 1063664894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 35592) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME113353) |
| 207L00000X Anesthesiology (Licence: NC 2016-00279) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2016-07-02 |