| NPI | 1760636518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282NC0060X General Acute Care Hospital, Critical Access (Licence: MA 232694) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MA 249403) |
| 282N00000X General Acute Care Hospital (Licence: MA 232694) | |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2020-06-11 |