| NPI | 1215270780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60578946) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA ML60380185) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2017-10-09 |