| NPI | 1790703072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME140855) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 177339) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2023-01-16 |