| NPI | 1265605273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA C155953) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME113017) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2018-07-11 |