| NPI | 1174642474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301087702) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301087702) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301087702) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2012-03-19 |