| NPI | 1902049083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME115707) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT194548) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194548) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2013-07-19 |