| NPI | 1598392607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME171010) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2026-01216) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-03-27 |