| NPI | 1265640940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME142372) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 43569) |
| 207L00000X Anesthesiology (Licence: MA 235860) | |
| 207L00000X Anesthesiology (Licence: CA A106542) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-01-20 |