| NPI | 1003550880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME179040) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC HANL-PYH3G0) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-06-29 |