| NPI | 1508178641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 56441) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 257928) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D79708) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2017-09-11 |