| NPI | 1669032082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME162398) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL82869) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-07-30 |