| NPI | 1548241565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME175802) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 155788) |
| 207L00000X Anesthesiology (Licence: NH 10444) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2025-08-29 |