| NPI | 1245373257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD154151) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 243014) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-10-10 |