| NPI | 1386892560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301099032) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME 110318) |
| Enumeration Date | 2008-08-31 |
| Last Update Date | 2026-06-01 |