| NPI | 1871755660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101262333) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: ME md19228) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2023-04-10 |