| NPI | 1720167216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 103558) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: FL TRN-9930) |
| 207L00000X Anesthesiology (Licence: MA 242423) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2014-11-05 |