| NPI | 1093979288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology Critical Care Medicine (Licence: CT 52648) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT193397) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT193397) | |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2014-06-24 |