| NPI | 1083925622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 301220) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207L00000X Anesthesiology (Licence: GA 72858) | |
| 207L00000X Anesthesiology (Licence: GA 072858) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2016-09-02 |