| NPI | 1669828125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME130645) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MN 61787) |
| 207L00000X Anesthesiology (Licence: NC 200001613) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2023-10-17 |