| NPI | 1942510615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 250044) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA BB5204071) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2016-01-25 |