| NPI | 1023216447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 110291) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT191054) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2013-06-19 |