| NPI | 1295362945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: FL ME166620) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME166620) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-04-03 |