| NPI | 1285072967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME135793) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R73895) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2018-08-16 |