| NPI | 1457588717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 26114) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME143687) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2025-12-08 |