| NPI | 1053670554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-00839) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182806) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2016-08-15 |