| NPI | 1255520854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MD D76955) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: FL ME112932) | |
| 207L00000X Anesthesiology (Licence: CA A137806) | |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2017-03-23 |