| NPI | 1235765223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-00953) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME168221) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2025-12-15 |