| NPI | 1083841126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 31783) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL31783) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116022750) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-08-17 |