| NPI | 1508006305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 105655) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 235537) |
| 207L00000X Anesthesiology (Licence: NY 235537) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2015-01-06 |