| NPI | 1003019670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 57439-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD60223818) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA MD60223818) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2017-12-06 |