| NPI | 1174645857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 246250) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT187998) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2011-07-07 |