| NPI | 1811215965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME118809) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL TRN#15934) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2019-07-23 |