| NPI | 1679836266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: RI DO01082) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 007285) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 252367) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2021-07-15 |