| NPI | 1114244357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS13131) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT013587) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT013587) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2015-06-29 |