| NPI | 1487944963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME146802) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 286869) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2025-01-30 |