| NPI | 1235373051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD168741) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT194553) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194553) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2015-01-15 |