| NPI | 1184061749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME145904) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 056772) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2020-09-30 |