| NPI | 1124317862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME141557) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 18866) |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: MN 63641) | |
| 207LC0200X Anesthesiology Critical Care Medicine (Licence: FL ME141557) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-04-12 |