| NPI | 1639102353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME165807) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 002005) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2025-07-10 |