| NPI | 1821221300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME140876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt194433) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2020-02-27 |