| NPI | 1164615720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2018-00672) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R7989) |
| 207L00000X Anesthesiology (Licence: IA SP-191) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2022-10-21 |