| NPI | 1104940311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VT 042.0011487) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 060-0003179) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2014-11-24 |