| NPI | 1578835419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME130945) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 28764R) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2023-07-14 |