| NPI | 1487195756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME147091) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 22027) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-03-11 |