| NPI | 1548654965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101278761) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME141095) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2026-03-19 |