| NPI | 1164865960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: NC 240674) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN 66983) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-01-11 |