| NPI | 1629590492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME150761) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 33281-R) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2021-07-01 |