| NPI | 1477875979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME102397) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101247626) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2018-05-31 |