| NPI | 1588001564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME13950) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA10355900) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT203800) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2019-08-21 |