| NPI | 1295855617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME103877) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301085678) |
| 207L00000X Anesthesiology (Licence: VA 0101264923) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-11-21 |