| NPI | 1104089242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OH 35.099377) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA mt190764) |
| 207L00000X Anesthesiology (Licence: PA MD443982) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-01-24 |