| NPI | 1104874742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: IA 39347) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 1316-TEP) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 49027) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-01-27 |