| NPI | 1174904668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL OS16032) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL UO4677) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4677) | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2020-01-14 |