| NPI | 1265057160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME175098) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A190865) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2025-08-05 |