| NPI | 1083608749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME85430) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME 85430) |
| 208D00000X General Practice (Licence: FL ME 85430) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2017-04-25 |