| NPI | 1710371703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VT 042-0014697) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 304371) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2020-07-07 |