| NPI | 1205087038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO 0054513) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 39.009748) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO tl2872) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2021-05-05 |