| NPI | 1073928768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 310142) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME133375) |
| 208800000X Urology (Licence: FL 20598) | |
| Enumeration Date | 2014-06-22 |
| Last Update Date | 2023-06-07 |