| NPI | 1124002167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 71834) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME 63244) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2009-01-29 |