| NPI | 1639159833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME158582) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX J6498) |
| 207P00000X Emergency Medicine (Licence: TX J6498) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-02-06 |