| NPI | 1528453255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME144300) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SD 0220) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207L00000X Anesthesiology (Licence: MA 278207) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2020-07-06 |