| NPI | 1366701500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2015-02395) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME130287) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182885) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2024-09-23 |