| NPI | 1174940209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME136129) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 85065) |
| Enumeration Date | 2014-03-26 |
| Last Update Date | 2024-05-07 |