| NPI | 1396302147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME168470) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: FL ME168470) |
| 207L00000X Anesthesiology (Licence: RI LP04885) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-09-05 |