| NPI | 1033368071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2012013498) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2008016718) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2014-09-02 |