| NPI | 1053577841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TN 48263) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: SC 35403) | |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2019-04-25 |