| NPI | 1205361011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME172881) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD474182) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: PA MD474182) | |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL ME172881) | |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2025-05-12 |