| NPI | 1053574939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME117825) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 061763) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-11-19 |