| NPI | 1932411261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME136141) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: LA MD.204891) |
| 208600000X Surgery (Licence: MS T-2306) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2018-12-04 |