| NPI | 1184920324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME142291) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 251450) |
| Enumeration Date | 2011-02-06 |
| Last Update Date | 2021-03-30 |