| NPI | 1902288194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 25ma10401500) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 263741) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2019-05-22 |