| NPI | 1255697827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301109130) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: MI 7301109130) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-07 |
| Last Update Date | 2017-07-31 |