| NPI | 1184981847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA 304949) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: LA 304949) | |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2017-05-12 |