| NPI | 1881215606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME0167001) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125.075986) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2024-07-01 |