| NPI | 1851675201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME154066) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA 105) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2022-08-04 |