| NPI | 1124322946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MA 269892) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MA 251673) | |
| 207L00000X Anesthesiology (Licence: MA 251673) | |
| Enumeration Date | 2011-01-09 |
| Last Update Date | 2017-03-11 |