| NPI | 1639326564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL TRN11689) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME103190) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2020-04-22 |