| NPI | 1790092898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME138874) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PR 20661) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2019-04-09 |