| NPI | 1952594913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME 111756) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2007017364) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2012-06-29 |