| NPI | 1700850955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME20241) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 011233596) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2008-03-28 |