| NPI | 1124238878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 060900) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0101239107) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-01-26 |