| NPI | 1760792303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME162717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS46385) |
| 207L00000X Anesthesiology (Licence: NC 2021-01085) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 251613) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2023-06-05 |