| NPI | 1801959549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 243050) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 230192) |
| Enumeration Date | 2006-12-17 |
| Last Update Date | 2021-10-21 |