| NPI | 1679935043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ME MD25293) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 311285) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VT 042-0015346) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 311285) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2022-01-03 |