| NPI | 1750328142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME68854) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 19125) |
| 207L00000X Anesthesiology (Licence: VT 042-0011148) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2019-08-28 |