| NPI | 1073995379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: KY 52777) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R3840) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2019-06-25 |