| NPI | 1629204243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V2713) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME113920) |
| 208D00000X General Practice (Licence: FL ME113920) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2025-10-21 |