| NPI | 1831619238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME150503) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 290666) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2024-02-08 |