| NPI | 1962645580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME137867) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 52223) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2020-09-01 |