| NPI | 1396010484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: LA 306704) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME127433) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2022-07-21 |