| NPI | 1962063891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2024-01285) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME161163) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2026-05-20 |