| NPI | 1962559773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME105588) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 43724) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-03-29 |