| NPI | 1366898918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 287617) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 1366898918) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2021-07-08 |