| NPI | 1588980320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME162357) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 36787) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2023-08-15 |