| NPI | 1548792054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: FL ME169945) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME169945) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-04-24 |