| NPI | 1982100996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME160610) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VT 042.0016501) |
| 207L00000X Anesthesiology (Licence: NH 22720) | |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2024-01-12 |