| NPI | 1083979017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 292160) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA 60700293) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 05988) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2018-03-27 |