| NPI | 1790195030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME150667) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA10328000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2021-06-08 |