| NPI | 1114247004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 123215) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2013-02203) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2015-08-30 |