| NPI | 1063972172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME163216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 283473) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 390200000X) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-07-04 |