| NPI | 1164099883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 032.0134249) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 290002) |
| 207L00000X Anesthesiology (Licence: NY 338348) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-07-11 |