| NPI | 1194113712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME144653) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35136353) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL ME144653) | |
| 208D00000X General Practice (Licence: PR 13571-I) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2020-08-18 |