| NPI | 1225261563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 57090) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 013441-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-09-03 |
| Last Update Date | 2019-12-17 |