| NPI | 1255759254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A143196) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 18865) |
| 207L00000X Anesthesiology (Licence: VT 042-0014692) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2022-06-01 |