| NPI | 1982921979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL MD.34457) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME123854) |
| 207L00000X Anesthesiology (Licence: LA MD.205379) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2019-04-18 |