| NPI | 1669739884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 293428-1) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 265859) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2018-09-10 |