| NPI | 1205253135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042.0014274) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 279014) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 279014) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2025-06-03 |