| NPI | 1326656000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME171226) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 59133) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2025-05-28 |