| NPI | 1790760643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME91539) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ND PT22173) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2025-03-13 |