| NPI | 1164885570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 97545) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME172473) |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2025-09-14 |