| NPI | 1053948497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TN 74206) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: ME MD23922) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-08-25 |