| NPI | 1770960031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 277292) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME133016) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2019-06-13 |