| NPI | 1972699395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2018-01050) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME102119) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-09-23 |