| NPI | 1053608208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IL 036.140822) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2011016976) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2016-07-25 |