| NPI | 1255452918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301080702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301080702) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: MI 4301080702) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-08-21 |