| NPI | 1003012345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35097219) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT190039) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 148156) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2015-05-18 |