| NPI | 1215221346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL 1215221346) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72845) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO DR.0054856) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2015-04-13 |