| NPI | 1649767526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME156669) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 280827) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 280817) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2023-12-29 |