| NPI | 1033473210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME138823) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 281702) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2025-08-18 |