| NPI | 1053702704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO CDRH0066617) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: NY 296623) | |
| 207L00000X Anesthesiology (Licence: CO DR.0066617) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2023-03-14 |