| NPI | 1538796990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101282142) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME169906) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-08-06 |