| NPI | 1245763101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME170869) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NE 31148) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2025-03-06 |