| NPI | 1649223512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME128420) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WY 6882A) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-03-24 |