| NPI | 1750661229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX BP10049598) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME140329) |
| Enumeration Date | 2011-08-27 |
| Last Update Date | 2021-01-11 |