| NPI | 1568807055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2019-02392) |
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: FL ME129022) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 18347) | |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2019-10-28 |