| NPI | 1881004687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME176448) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 293341-1) |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2025-10-06 |